BI23 Erythrodermic eczematous reactions to immunoglobulins

Abstract Intravenous immunoglobulins (IVIg) have been used in clinical practice for more than 50 years. They are dermatological indications such as dermatomyositis, pemphigus and Kawasaki disease. Although this is regarded a safe treatment modality, it can produce adverse reactions the skin. We report two patients with IVIg-induced skin changes. A 71-year-old man no preceding disease was under neurology care of chronic inflammatory demyelinating neuropathy (CIDP) IVIg. He presented an erythrodermic eczematous rash symptomatic pain pruritus. The started on hands had spread to rest body 3 days after completion his third course treated topical clobetasol propionate. His settled over few weeks. patient keen resume IVIg CIDP; unfortunately, he developed severe rapid reaction retrial be stopped. An 82-year-old given CIDP. denied any previous conditions or atopy. received 5-day followed by intravenous methylprednisolone 1 g once daily 6 days. Four weeks later, pompholyx palms thereafter widespread arms, abdomen, back face. propionate trunk limbs clobetasone butyrate symptoms treatment. Eczematous immunoglobulin often under-recognized. Reactions preferentially affect middle-aged men those being neurological presentation peculiar distinctive, almost always involving palmoplantar aspects dyshydrotic element. pattern starts within exposure become erythrodermic. Histology shows spongiotic dermatitis not diagnostic. Immunoglobulin-associated eczema persist even discontinuation immunoglobulins. Recommended depends severity. If mild, continuing steroids should considered. persists worsens, up switches brand In persistent cases, methotrexate may beneficial. mechanism fully understood. diagnosis clinical, high index suspicion required. these requires collaboration between dermatologists physician prescribing immunoglobulin, who unfamiliar event.